ASSESSING MODERATED MEDIATION IN THE RELATIONSHIP BETWEEN SYMPTOM COUNTS, FALLS, AND HEALTH OUTCOMES

Abstract Almost half of older adults experience multiple symptoms that limit function and increase the risk for falls. The study aimed to determine if the relationship between symptoms (pain, endurance, weakness, balance, depression/anxiety) and outcomes (hospitalization, residential care, activity limitations, wellbeing, and mortality) are mediated by falls and whether symptoms further moderate outcomes of falls. Data from community-dwelling older adults (≥ 65 years, n=4921) enrolled in the National Health and Aging Trends Study (NHATS) 2015 cohort were used for analysis. Symptoms were categorized by symptom count (0, 1, 2, 3, 4, ≥5). Using generalized structural equation modeling, 2015 symptom counts were modeled to predict 2016 falls, 2016 health outcomes, and 2017 mortality. Falls partially mediated the association between symptoms in one year and outcomes the following year for all except residential care. In addition, the effect of falls on hospitalization is significantly moderated by symptoms (interaction of symptoms and fall OR=.89, robust SE=.045, p=.025). This dampening effect indicates that the overall effect of falls on hospitalization (OR=2.19, robust SE=.36, p<.001) is stronger at the lower levels of symptom count and weaker at the higher levels of symptom count. When there are ≥5 symptom present, there is no significant difference between the predicted probability of hospitalization for those who have not experienced a fall (.31, 95%CI: .28 to .34) and those who have fallen (.36, 95%CI: .31 to .41). Understanding the complex relationship between symptoms, falls, and outcomes can assist with developing interventions for symptom management and fall prevention.

When there are ≥5 symptom present, there is no significant difference between the predicted probability of hospitalization for those who have not experienced a fall (.31, 95%CI: .28 to .34) and those who have fallen (.36,95%CI: .31 to .41).Understanding the complex relationship between symptoms, falls, and outcomes can assist with developing interventions for symptom management and fall prevention.Adherence to the PD COS may improve research quality and study comparability.Objective: Analysis of the COS uptake rate before and after the PD COS publication.Methods: On June 26th, 2023, we conducted a search of ClinicalTrials.gov to retrieve phase III/IV adult PD trials between 2013 and 2023.Screening for inclusion and data extraction occurred in a masked, duplicate fashion.Trial characteristics and COS uptake rate were extracted from this sample.Results: In our 111 included trials, the COS uptake rate was highest for the 'Walking and Balance' outcome and lowest for the 'Hospital Admissions' outcome.Overall, there was a non-significant monthly increase of 0.26% (P = 0.266, CI = [-0.20,0.72]) in "COS-defined outcome" measurement when comparing pre-and post-COS publication.Conclusion: Overall, our study found no significant increase in COS uptake in PD clinical trials.We found multiple outcomes to be vastly unmeasured and heterogeneity among the measurement instruments used.These findings introduce complexity to the standardization and comparability of RCT outcomes.Barriers to COS uptake may be complex; however, overcoming these factors is vital to improving the usefulness of PD research.

ASSESSMENT OF DECISIONAL COMPETENCE IN DEMENTIA-A QUALITATIVE STUDY OF 60 EUTHANASIA CASES
Arne van den Bosch, Radboud Marijnissen, Denise Hanssen, and Richard Oude Voshaar, University Medical Center Groningen, Groningen, Groningen, Netherlands The Netherlands allows euthanasia or assisted suicide (EAS) for people with dementia.The number of dementia EAS cases gradually increases every year, up to 288 cases in 2022.This practice remains controversial, as dementia is not directly lethal and may impair decisional competence.The Dutch euthanasia review committees (RTE) refer to Appelbaum and Grisso's criteria for the assessment of decisional competence, but how these criteria are applied in clinical practice remains unknown.This study examined qualitatively which factors, and how, influence the judgment of decisional competence for EAS requests of people with dementia.Thematic analysis of 60 dementia EAS case summaries published online by the RTE between 2012 and 2021.Twenty patients had an advance directive and were decisionally compromised at time of EAS.Forty patients were decisionally competent at time of EAS, of which twenty also had an advance directive (purposive sampling).Two researchers independently coded all text related to decisional competence.A theoretical framework was developed.The four cognitive criteria of Appelbaum and Grisso were dimensional and cut-off points were influenced by six supporting factors that also directly impacted on competence assessment, i.e., level of communication, psychiatric comorbidity, personality, presence of an advance directive, consistency of the request, and the patient-physician relationship.The number of involved physicians and executed investigations were two contextual factors.The multidimensionality and subjectivity of decisional competence assessment may pose ethical and legal challenges.Continuous quality improvement processes may be needed in daily care, including possibilities for reflection.

ASSESSMENT OF DEFICITS IN SPECIFIC COGNITIVE DOMAINS IN OLDER ADULTS LIVING WITH HIV (OALWH)
Andrea Reyes-Vega 1 , Harideep Samanapally 1 , Rishikesh Rijal 1 , Stephen Furmanek 2 , Christopher B. Shields 3 , Brandon C. Dennis 3 , Smita Ghare 3 , and Shirish Barve 3 , 1. University of Louisville, Louisville, Kentucky, United States, 2. Norton Infectious Diseases Institute, Louisville, Kentucky, United States, 3. Norton Neuroscience Institute, Louisville, Kentucky, United States A significant proportion of people living with HIV (PLWH) have cognitive impairment.Moreover, approximately 70% of PLWH in the United States will be ≥50 years old by 2030, raising concerns of a higher incidence of dementia as they age.Accordingly, there is a clinical need to monitor their cognitive status.The aim of this study was to delineate specific cognition areas impacted in OALWH with a clinical diagnosis of neurocognitive impairment.We used a comprehensive set of tests (paper and NIH Toolbox Cognition Battery), to assess different cognitive domains in a total of 25 OALWH ≥ 50 years.64% were diagnosed with neurocognitive impairment and 36% were non-impaired.T-scores were compared using t-tests of means.Differences in means and 95% confidence intervals (CI) were reported.Impaired patients scored on average 18.35 T-score points lower on Hopkins Verbal Learning Test (HVLT) retention trial (p 0.016, CI:6.74-29.97)and 9.19 T-score points lower on the NIH Picture Vocabulary Test (PVT) (p 0.033, CI:1.12-17.26).Stroop color word, NIH Card Sort and NIH Picture sequence memory test were trending to be significantly lower in impaired patients (p< 0.07).In impaired OALWH, the HVLT data demonstrated a decreased capacity to learn and an early memory loss, suggesting frontal executive and attention type deficits.Moreover, the decreased PVT scores demonstrated an impact on crystallized intelligence, indicating decline in verbal skills, semantic knowledge, or retrieval.Overall, the observed deficits in different cognitive domains support early neurocognitive screening even when OALWH do not show overt signs of neurocognitive impairment.

ASSESSMENT OF ELECTROLYTE ABNORMALITIES IN OLDER ADULTS WITH COVID-19 DELIRIUM
Milenko Petrovic, Esther Park, Amanda Pangle, Jeanne Wei, and Gohar Azhar, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States This retrospective study explored the impact of COVID-19 on altered sodium and potassium in older adults with delirium.EMRs from the University of Arkansas for Medical Sciences (UAMS) database were reviewed from January 7, 2018 to January 5, 2021 for electrolyte abnormalities and delirium.Inclusion criteria were age 65 or older, all races, genders, and ethnicities with COVID or non-COVID infections.We identified 319 patients with COVID-19 out of which 108 (33.8%) had delirium during COVID.In COVID-delirious patients, hypokalemia was present in 8, hyperkalemia in 10, hyponatremia in 9, and hypernatremia in 20.127/319 (39.8%)COVID patients had an electrolyte disorder at some point with hypokalemia being most represented at 58/127 (45.7%).Out of the patients who experienced hypokalemia at some point, 34/319 (10.6%) had delirium.In another cohort of 306 older adults with non-COVID pneumonias we identified 173 patients with electrolyte disorders and 106 (34.6%) with delirium during pneumonia.Electrolyte disturbances were more present in non-COVID pneumonias vs. those with COVID (p< 0.001).Hypokalemia was more identified in non-COVID, 56/306 (18.3%), vs. COVID patients, 34/319 (10.6%) (p< 0.006).Interestingly, hypernatremia was greater in COVID groups (p< 0.0321).There was no difference in delirium between COVID vs non-COVID patients, but electrolytes disorders and hypokalemia were observed with greater frequency in non-COVID pneumonias.Notably, hypernatremia developed more in patients suffering from COVID and since it can be associated with seizures and cerebral hemorrhage, particular attention should be paid to prevent hypernatremia from developing in order to reduce COVID-related morbidity and mortality.

ASSOCIATED FACTORS OF PARTICIPATION IN DIGITAL TECHNOLOGY: A STUDY BASED ON OLDER PEOPLE IN CHINA
Lan Liu 1 , Chao Guo 2 , Liangshu Qi 3 , Yingying Wang 1 , and Ruixin Shu 1 , 1. Institute of Population Research, Peking University,Beijing,Beijing,China (People's Republic),2. Peking University,Beijing,Beijing,China (People's Republic),3. School of Economics and Management,Beijing,Beijing,China (People's Republic) There has been an increasingly important trend that more and more older people take part in activities of digital technology nowadays in China.In this study, the research question associated to determinants of older people's digital engagement was addressed, which has been quantitatively analyzed by statistical models in a sample of older people 60 to 98 years of age from China Longitudinal Aging Social